You probably have done this, but recognizing this is ultimately his choice, I would still choose to try and reason with him. I don’t know how old he is, but the years that he has left to live after treatment might be many. And his choice effects family around him that love and care for him, and need him to be around in their lives as well. There is a lot of living yet to do, and choosing to let this run its course will be a very unpleasant way to leave this world. This in no way will be a death without pain in your sleep one night. Many people that I’ve communicated with over the years are initially more afraid of the treatments than the cancer that is poised to take their lives. Everyone has heard about how bad radiation can be, how sick chemo can make you, and the specter of those imagined challenges looms large.The luxury of feeling like that quickly diminishes when the real discomfort of an advanced cancer kicks in.

The problem then will be that by putting off treatments, to the place where the fear of the cancer, death, prolonged serious pain and illness is now the most feared thing, it will be far harder to treat and involve more invasive treatments that have a lower chance of being successful. Many oral cancer types that spread by perineurial invasion end up as brain cancers since the nerves in the oral environment all lead back to the base of skull. Then things become far more complicated.

Where he is mentally and physically is not where he will be in the future. That argument needs to be absorbed and weighed in the balance of how he envisions his future. This post may seem blunt and harsh. I may even get some flack for writing it. I’ll probably hear that it is his decision, and I we should let him decide what is best for him. But time is not his friend, and I’ve seen lots of 11th hour conversions from letting it run its course to deciding that treatment is the desired path. Most with poor outcomes. Those still bother me that I could not reach someone early in their fears of treatment. There is a mix of empathy and support that needs to be conveyed for sure in the discussions. But when all else fails, a dose of reality may need to be introduced to convince him that his path of non treatment will be far worse than he ever imagined the treatments to be. I apologize if you find this writing devoid of empathy. That is not my intention.

Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.